Concern and anger sees over 4,000 healthcare professionals use social media to wade into physician associate debate, according to new study

Concern and anger sees over 4,000 healthcare professionals use social media to wade into physician associate debate, according to new study

New research has found that more than 4,000 UK healthcare professionals (HCPs) have used social media to engage in online conversations surrounding the role of physician associates in the National Health Service (NHS), as the Health Secretary announces a review into their role aimed at taking the “heat out of the issue”.

A study by leading digital insights consultancy Creation Healthcare found that UK HCPs posted more than 75,000 times on X (formerly Twitter) between January 2023 and September 2024 referring to physician associates, particularly in relation to government action, pay disparities, and the nature of the role within the NHS.

The debate has drawn particular attention in recent days following Wes Streeting’s announcement that Professor Gillian Leng, a former chief executive of the NHS drugs advisory body the National Institute for Health and Care Excellence, would lead an official review into how physician associates are being deployed in the health service, and what safeguards are needed going forward.

Creation Healthcare’s study, which tracked HCP conversation from January last year, found that discussions around physician associates started to gather momentum in late 2023, and peaked in March 2024. This was spurred on by media coverage at the time, including the release of the Royal College of Physicians survey data on members’ views of physician associates, and a Telegraph article revealing the extent to which physician associates were being used as “substitutes” on doctors’ rotas in over 30 NHS hospitals. 

What drove HCP conversation in the study period?

Frustration and criticism at governing bodies

Creation Healthcare’s research identified significant underlying concern - and often anger - about the issue surrounding the role of physician associates in the NHS. Several high-profile HCP commentators were found to have shared posts deemed to be ‘strongly negative’ in sentiment. For example, Dr Rachel Clarke, a palliative care physician and author with more than 280,000 followers on X, expressed “disbelief” at the range of degrees that were being allowed as prerequisites for the two-year physician associate course at some universities - with concern that patient safety was being compromised as a result.

The study also identified frustration angled towards governing bodies and organisations - including the UK government itself. From January 2023 to September 2024 UK HCPs shared posts more than 4,000 times on X concerning the government and governmental decisions on this matter. Of these, just over one per cent were of positive sentiment, while a far larger 36 per cent were negative. One healthcare professional, Dr Trisha Greenhalgh, a primary care professor and retired GP in Oxford, shared a post in which she claimed the government was “bankrolling the hiring of underqualified physician associates” leading to  an increasingly limited number of GP training places. Her post was shared by 127 other UK HCPs and over 2,300 times by the international public, garnering 5,189,047 total impressions. 

Though posts of a neutral sentiment appeared to make up the majority, Creation’s research found that the specifics of these implied a latent negativity towards government action.

Medical governing bodies also attracted criticism from HCPs, according to the analysis. The management of the integration of physician associates into the NHS workforce came under heavy scrutiny, particularly in reference to the ‘misrepresentation’ of physician associates to the public. The Royal College of Physicians was also criticised for its handling of a survey investigating its members’ views on physician associates, after which the College’s president stepped down. 

The prominence of these posts was reflected in the focus of the most-shared posts by UK healthcare professionals in the study period. The first, shared by 254 UK HCPs, discussed misrepresentation of the role of physician associates, while the second, shared by 185 HCPs, discussed the situation at the Royal College of Physicians. The three most-shared posts had combined impressions of 9,647,636.

Call for justice over pay issues

The study also found that, between January 2023 and September 2024, more than 5,000 posts from UK HCPs on X were found discussing the pay rates of physician associates - including comparisons of the respective salaries of resident doctors and physician associates. Prior to the Chancellor’s 22 per cent pay rise award for resident doctors back in July, one healthcare professional decried a “weird alternate reality” in which physician associates, despite less clinical education, were earning more than resident doctors.

A call for calm

Despite much concern about the implications of physician associate roles on patient care, Creation Healthcare also found a number of HCPs who expressed opposition at the ‘harmful rhetoric’ being employed against serving physician associates.

Dr Farhad Peerally, a gastroenterologist in Kettering, said that he was “appalled” by the hate some physician associates had received on social media, and instead praised the “fantastic assets” that these healthcare professionals can prove when working “within the right setup”. 

What do physician associates online think?

Using CREATION Pinpoint technology, the analysis was also able to distil the online conversations of physician associates who were themselves involved in discussion. In total, it found 19 former or current physician associates posting original content about the ongoing debate. While just a small fraction of the total HCPs active, they contributed 338 original posts. 

Their views on the matter varied: one former physician associate, Adam Skeen, now studying medicine full-time, expressed frustration at the pay-cut that a physician associate would face when they progressed into a role as a junior doctor. “Going from PA to Doctor should be a promotion, with pay to reflect this”, Skeen added. Heather Reid, a physician associate working in Scotland, shared the “exhausting” nature of the role in the current climate. “Constantly undermining and criticising the role does little for the cause”, she continued, later adding that the physician associates can offer “junior” doctors an opportunity to “go to teaching and to get time in resus and in [paediatrics] as well, instead of just service provision in majors”.

Despite the worries some physician associates have expressed online, most seem to be in favour of improving guidance related to their roles. Ruth Berry, a physician associate in the Birmingham area praised the passage of the Anaesthesia Associate and Physician Associate Order 2024, hoping that regulations would ensure physician and anaesthesia associate courses are “properly accredited” and “medical associate professions” were “accountable for their actions”. Berry later shared, however, that particular narratives around the role of physician associates in some medical circles were eroding “pride in [her] professional identity”.

Commenting on the analysis, Daniel Ghinn, CEO of Creation Healthcare, said:

“These extensive discussions among healthcare professionals highlight the importance of addressing the physician associate debate thoughtfully. 

“There is clearly much emotion invested in arguments on either side of the debate. That’s why listening effectively to the experiences of healthcare professionals themselves will be key to the success of any review.

“The unprompted social media conversations of healthcare professionals offer a key window into the concerns, priorities, and perspectives of those on the frontlines of healthcare provision across the country. Decisionmakers can benefit hugely from an effective understanding of these.”